Diagnostic Dilemmas in Assessing Older Adolescents and Young Adults for Learning Disabilities: Chang

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Diagnostic Dilemmas in Assessing Older
Adolescents and Young Adults for Learning
Disabilities Changes in the Discrepancy Between
IQ and Achievement

• J. Mark Davis, Ph.D.
• Noël Gregg, Ph.D.
• Chris Coleman, M.A.
• Margo Habiger, Ed.D.
• Robert Stennett, M.S.
• The Regents Center for Learning Disorders
• at The University of Georgia

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Critical Issues Impacting Documentation for
Accommodating Learning Disabilities in Higher
Education throughout the United States

• Litigious climate
• Definition
• Eligibility criteria
• Functional limitation
• Comparison group/high functioning adults
• Adequate assessment tools
• Research

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Climate

• Students with LD continue to be fastest growing
  group the percentage increased from 25 percent
  in 1991 to 41 percent in 1998 (of students with
  disabilities).
• Students enrolling in more four-year colleges and
  universities.
• Graduate/Professional student enrollment
  increasing.

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Court Cases

• Guckenberger v. Trustees of Boston University,
  1998
• Price et al. v. The National Board of Medical
  Examiners, 966 F. Supp. 419. 1997.
• Root v. Georgia State Board of Veterinary
  Medicine, 2000
• Bartlett v. New York State Board of Law
  Examiners, 1997, 1998, 2000.
• Sutton v. United Airlines, Inc.(1999)

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Court Decision-Making

• Different than professional
• Assess nondiscrimination for an individual
  circumstance

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Postsecondary Requirements

• Documentation
• Appropriate professional qualifications
• Recent documentation
• Comprehensive documentation
• Accommodations supported by specific documentation

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Eligibility CriteriaGateway to Accommodations

• Cut-off (Siegel, 1989)
• Discrepancy/regression models
• Clinical/differential models

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Definitions/Eligibility Criteria

• Significant difference between definitions used
  and eligibility criteria applied.
• Intelligence often not part of definitions but
  central to eligibility criteria.
• Cognitive processing often part of definitions
  but not central to eligibility criteria

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Discrepancy Model

• Discrepancy models are models of prediction -
  that is, one measure (ability) predicts the other
  (achievement).
• More highly correlated the measures - more
  difficult to find discrepancy.

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Predict or Diagnose

• Ability/Achievement Discrepancy
• purpose is to predict achievement
• Intra-individual Discrepancy
• purpose is to diagnose

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University of Georgia StudyBrackett McPhearson
(1996)
Eligibility Models Postsecondary (N173)
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Purposes of Current Study

• Highlight difficulties in re-evaluating
  individuals using a clinical sample.
• Examine differences the in application of
  diagnostic practices.
• Review the implications of evaluation practices
  on individuals with disabilities.
• Evaluate the impact of a legal movement in the
  U.S. (using a highly conservative cut-off score
  approach to define disabilities).

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• In regard to word decoding, instruments that
  are commonly used for children may not be
  appropriate for adults. If the norms of
  traditional standardized word-recognition tests
  are usedsomewould not be classified as
  dyslexic. (Bruck, 1990)
• Despite, as a group, scoring in the average range
  on a standardized measure of word decoding,
  adult dyslexics do not use age-appropriate, and
  in some cases reading-level appropriate, word
  recognition processes (Bruck, 1990)
• standardized test measuresdo not reveal the
  full nature of the types of spelling problems
  encountered by dyslexics. Such tests contain
  items that are psychometrically rather than
  theoretically based. (Bruck, 1993)

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• someone with truly abnormal abilities,
  especially in language, would not likely gain
  admission to competitive institutions of higher
  learning. (Gordon, Lewandowski, Keiser, 1999)
  

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Procedure

• Reviewed evaluation records of Regents Center
  clients for 1998 March 2001, selecting clients
  with available reports of previous evaluations
  that contained IQ scores and test scores for at
  least one of the following
• Pseudoword Decoding
• Real word decoding
• Reading Comprehension
• Spelling
• Mathematical Calculation Skills
• Prior tests were compared to results of a
  comprehensive psychoeducational evaluation
  conducted at the Regents Center.

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Regents Center For Learning Disorders (RCLD)
Criteria For Learning Disabilities

• IQ within, or above, the average range
• Academic deficit in one or more, but not all
  achievement areas
• Processing deficit(s) associated with each
  academic deficit

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RCLD Criteria for Learning Disabilities Required
Information in the Diagnostic Report

• IQ Measure
• Processing Deficits and Strengths on Multiple
  Measures of Processing
• ? Attention/Working Memory
• ? Learning/Memory (Short-term and Long-term
  Memory)
• ? Executive Functions/Reasoning
• ? Visual-Spatial/Visual-Motor
• Oral Language Skills (Phonological/orthographic
  processing, verbal fluency, vocabulary, listening
  comprehension, syntax, discourse, etc.)
• Social-Emotional Status
• Academic Deficit(s)
• ? Reading Decoding, Reading Rate, Reading
  Comprehension
• ? Written Expression (spelling, grammar,
  punctuation)
• ? Math calculation and Math Reasoning

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Sample Characteristics

• 378 Students Evaluated at the Regents Center
  from 1998 March 2001.
• 248 (65.6) had previously diagnosed learning or
  attention disorders, or language disorders
  impacting academic success.
• 152 of those 248 (61.3) had prior reports
  available for review.
• 127 had reports with IQ scores and at least one
  score on an academic skills test (83.6 of the
  152 with available prior reports One in six
  reports failed to contain such information).

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Sample Characteristics (continued)
? 63 agreement between previous evaluators and
RCLD (80 cases) ? Difference in classification
of prior and RCLD classification is statistically
significant (Pearson X² 85.58 (df 18), p lt
,01)
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p lt .01 (Level of Significance for All
Analyses)
Comparisons of Group Means for IQ and Achievement
Scores
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Trends

• Composite IQ score drops
• Pseudoword reading scores increase
• Realword reading scores increase
• Reading comprehension score drops
• Spelling scores remain the same
• Math scores remain the same

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Implications

• Comprehensive Assessment
• Clinical Diagnostic Model
• - Scores Dont Drive Diagnosis
• - Cut-Off Scores Are Arbitrary
• - Cut-Off Scores Can Miss Clinically
  Significant Problems
• Discrepancy models are biased
• - Cut-offs over identify LD in low functioning
• - Discrepancies over identify LD in high
  functioning
• Evaluator Background
• - Reading Disorders
• - Language Disorders
• Better Instruments
• Research

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References

• Brackett, J. McPherson, A. (1996). Learning
  disabilities diagnosis in postsecondary students
  a comparison of discrepancy- based diagnostic
  models. In N. Gregg, C. Hoy, A. Gay (Eds.),
  Adults with learning disabilities theoretical
  and practical perspectives (pp. 68-84). New
  York Guilford Press.
• Bruck, M. (1990). Word-recognition skills of
  adults with childhood diagnoses of dyslexia.
  Developmental Psychology, 26 (3), 439-453.
• Bruck, M. (1993). Component spelling skills of
  college students with childhood diagnoses of
  dyslexia. Learning Disabilities Quarterly, 16,
  171-184.
• Gordon, M., Lewandowski, L., Keiser, S.
  (1999). The LD label for relatively
  well-functioning students a critical analysis.
  Journal of Learning Disabilities, 32 (6),
  485-490.
• Siegel, L. (1989). IQ is irrelevant to the
  definition of learning disabilities. Journal of
  Learning Disabilities, 22, 469-486.

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Case Example Grant

• 19-year-old, right-handed, high school (private)
  senior applying to UGA
• First diagnosed with learning disabilities at age
  8 (2nd grade)
• Tested at ages 8, 11, 14, and 19 (RCLD)
• Placed in a speech impaired program in public
  school (grades 2-5)
• Special education services 2nd 9th grades in
  public school
• Repeated 9th grade
• Language retraining programs in private high
  school (resource classes 10th-11th and mainstream
  classes 12th)
• Accommodations Extra time on exams, word
  processor, spell check, tutoring
• Math and science always strong areas, no need for
  resource classes

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Case Example Grant (continued)
VIQ 84, PIQ 115, FSIQ 98 Verbal
Reasoning 95, Abstract/Visual 94,
Quantitative 94, Short-term
Memory 71, Composite 82 Crystallized
88, Fluid 107, Composite 97
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Case Example Grant (continued)

• Spelling Errors
• equiment equipment
• occupie occupy
• illolgical illogical
• fumiual familiar
• fecision decision
• prejudious prejudice
• loqwasious loquacious
• ireasitable irresistible
• arerickularel auricular
• necissary necessary
• jewery jewelry
• mite might
• fells feels
• secdule schedule

• Decoding Errors
• guarantee quarantine
• decorate deteriorate
• mosic mosaic
• au-cicious audacious
• longevetivity longevity
• re-gin regime
• stinglies sentinels
• trogent torrent
• adminition admonition
• clutish cultish
• Invotation innovation
• excusting executing
• castrophes catastrophes
• age idea

Spontaneous spelling errors
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Case Example Grant (continued)

• Results of other testing revealed Deficits in
• ? Phonological working memory
• ? Receptive language
• ? Reading rate
• ? Written expression in spontaneous essays
  (grammar, punctuation, word choices)
• Strengths were in
• ? Visual learning and memory
• ? Nonverbal reasoning
• ? Interpersonal skills
• Summary
• ? Would not have met criteria for LD in areas
  of historic difficulty (reading and writing)
  based on scores listed previously
• ? Would not have met criteria based on a 16th
  ile cut-off score for reading and writing
• ? Would therefore not continue receiving
  accommodations (including high-stakes tests) or
  special consideration for university admission

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Case Example Charles

• Background
• 27-year-old, right-handed, graduate student
  (doctoral program in education)
• First diagnosed with learning disabilities at age
  9 (3rd grade)
• Tested at ages 9, 18, 19, and 27 (RCLD)
• Previously diagnosed with dyslexia, dysgraphia,
  and dyscalculia
• Attended a special school catering to students
  with LD (3rd 6th grades)
• Placed in an individual study program with only
  7-8 students per class in private school (grades
  7-8)
• Special education services 9th 12th grades in
  public high school
• Continued receiving accommodations within the
  learning disability program as he completed a
  four year college degree and a two-year masters
  degree program (in which he earned a 3.4 GPA)
• Accommodations Reader for exams, word
  processor, spell check, proofreader, required
  reading on audio tape, and notetakers

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Case Example Charles (continued)
VIQ 100, PIQ 84, FSIQ 92 VIQ 98,
PIQ 83, FSIQ 91
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Case Example Charles (continued)

• Spelling Errors
• eloggical illogical
• faimalr familiar
• pshiscan physician
• prejudence prejudice
• necceaity necessity
• assuages assiduous
• loquatis loquacious
• erasable irresistible
• aricliuar auricular
• eardesisents iridescence
• scriticputes scriptures (?)
• divoraces divorces

• Decoding Errors
• quarateen quarantine
• resistance residence
• mosak mosaic
• audience audacious
• perdelication predilection
• vaccination factitious
• eflianoman epithalamion
• ineffective inefficacious
• cyanide synecdoche
• betity beatify
• lubrication lucubration
• puerical puerile

Spontaneous writing errors
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Case Example Charles (continued)

• Results of other testing revealed Deficits in
• ? Phonological Processing
• ? Orthographic Processing
• ? Visual-spatial abilities
• ? Working memory
• ? Processing Speed
• ? As suggested by select test scores, reading,
  spelling, and mathematics
• Strengths were in
• ? Practical Reasoning
• ? Study habits, including use of accommodations
  and assistance
• ? Perseverance
• Summary
• ? Would have met criteria for LD in reading
  comprehension (if NDRT was allowed), spelling,
  and math based on a one standard deviation
  discrepancy model using scores listed previously
• ? Would have met criteria based on a 16th
  ile cut-off score for reading comprehension,
  spelling, and mathematics, and possibly decoding
  (pseudoword but not real word)
• ? Clearly it is possible to succeed at
  University despite learning deficits

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Contact

• Noël Gregg, Ph.D.
• ngregg_at_coe.uga.edu
• www.coe.uga.edu/ldcenter